HomeMy WebLinkAbout0589 OeCiaratlon ot Qo~niCile and Citizenship ~
TO THE STATE ANO COUNTY TAX ASSESSOR,
Si . WCtE COUNTY, FIORtDA: ~ ~ V 6 3 q
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This is my declaration of pom~t~le and Citizenship in the State of Flo~ide that t am Filing th+s day in eccordance and
~n conform~ty w~th Chaprer ?22, Section 222,17, Florida Statutes.
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I was formeriy a legal resident of - _ _ . _ ,
(City) (Sfate)
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and 1 resided at ."~S ~r~ r~~
- - _ . . . However 1 have changed my domic.ile
(Street and Number) ' '
ro and am and have been a bona fide resident of the State of Florida since _ day of
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_-11.~ Z . , 19 and 1 reside at ~ _ „~,~vt- -
(Streef and Number)
FQRT MERCE, SAINT lUClE COUNTY, FLORIDA
and this s~atement ~s tc be taken as my declaration of citize~ship, actual legal residence and domicile in the State of fiorida.
(I~sert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at forme. domicile, removal of famity to new domicile, purchase of home, etc.) ~
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CLER~ CIA~t~WIR1
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1 FURTHER CfRTIFY that I will comply with all othe~ requirements of a leyal resident of this State. ~
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1 FURTHFR CERTIFY that I have no intention to return to my forme~ domiGle, and 1 intend to remain in FORT '
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PIERCE, SAINT't~1~lE COUNTY, FLORtOA, permanently. . .
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Swwn to and subscribed before me this _"~S _ day of _~~'!L"'__ ~q 7'/_.
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ROGER rO1TRAS
CIRCUIT COURT Notary Public
BY D.C. My Commission expires
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Ro b~ ~x~cvbd in dupliuH •nd oriqenal ~i1ed witl~ Cl~rlc Cirsuil Cour1, and dupliut~ witl~ Tax Assssaor.)
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